European studies on breast lymphatic mapping.

Sentinel lymph node (SLN) biopsy is rapidly emerging as a minimally invasive alternative to standard axillary dissection for nodal staging in breast cancer. So far only data from case-control trials are available documenting SLN biopsy to be highly predictive of axillary node status, with a false-negative rate of less than 5%. The procedure has the potential to identify those patients most likely to be helped by axillary dissection (ie, those with positive nodes) and to spare node-negative patients, who cannot benefit, from the morbidity of an operation. No data exist from randomized trials focusing on the oncologic safety of the SLN biopsy alone or the expected reduced postoperative morbidity. Therefore, results from randomized trials validating SLN biopsy in breast cancer are required before accepting the procedure as the standard of care. This review discusses the European multicenter randomized trials addressing the pros and cons of SLN dissection, either as a surrogate for conventional axillary dissection or to examine aspects of the procedure itself. The trials identified are the ALMANAC trial (Axillary Lymphatic Mapping Against Nodal Axillary Clearance); the AMAROS-EORTC trial (After Mapping of the Axilla: Radiotherapy or Surgery); the KiSS study (German Clinical Interdisciplinary Sentinel Study); the Milan trial (European Institute of Oncology); the Fransenod study (French Randomised Sentinel Node Study); and the IBCSG 23-01 trial (International Breast Cancer Study Group Trial 23-01).